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Postnatal intervention for the treatment of FNAIT: a systematic review

Abstract

Objective

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality.

Study design

MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018.

Result

Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 × 109/L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion.

Conclusion

Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion.

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Acknowledgements

We thank Elizabeth Uleryk for the search strategy; and Sylvia Torrance and Kimberly Figures for administrative assistance.

International Collaboration for Transfusion Medicine Guidelines (ICTMG)

Shubha Allard, MD, FRCP, FRCP(Path), Barts Health NHS Trust and NHS Blood & Transplant, UK; Celso Bianco, MD, formerly with America’s Blood Centres, USA; Jeannie Callum, BA, MD, FRCPC, CTBS, University of Toronto, Canada; Veerle Compernolle, MD, PhD, Belgian Red Cross, Flanders, Belgium; Dean Fergusson, MHA, PhD, University of Ottawa, Canada; Mark Fung, MD, PhD, University of Vermont Medical Center, USA; Susan Nahirniak, MD, FRCPC, University of Alberta, Canada; Katerina Pavenski, MD, FRCPC, University of Toronto, Canada; Joanne Pink, MBBS, FRACP, FRCPA, Australian Red Cross Blood Service, Australia; Arjuna Ponnampalam, MD, FRCPC, University of Manitoba, Canada; Paolo Rebulla, Ospedale Maggiore Policlinico, Italy; Cynthia So-Osman, Sanquin, Netherlands; Simon J. Stanworth, MA, MRCP, DPhil, FRCPath, University of Oxford, UK; Zbigniew M. Szczepiorkowski, MD, PhD, Dartmouth-Hitchcock Medical Centre, USA; Alan T. Tinmouth, MD, FRCPC, MSc, University of Ottawa, Canada; Erica Wood, MBBS, FRACP, FRCPA, Monash University, Australia.

Author contributions

JMB reviewed the citations, analyzed data, drafted the initial manuscript, and participated in critical revisions of the article. HH reviewed the citations, analyzed data, drafted the initial manuscript, and participated in critical revisions of the article. NS reviewed the citations, extracted data and supported all drafts of the manuscript. ST extracted data and supported all drafts of the manuscript. DL finalized the tables and figures, participated in the interpretation of data, and critical revisions of the article. TB, LL, and EM reviewed citations, participated in the interpretation of data, and critical revisions of the article. JB, MFM, AG, DMA, SB, GB, MK, CK, JK-K, DO, HS and GR participated in the interpretation of data and critical revisions of the article. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding

Canadian Blood Services partially funded this study. Canadian Blood Services did not have any role in the design, analysis, and interpretation of the data or preparation, review, and approval of the manuscript.

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Correspondence to Jillian M. Baker.

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Conflict of interest

MK and JK-K are two of the founders and owners of Prophylix Pharma AS, a Norwegian biotech company coordinating the EU-funded PROFNAIT Consortium which is developing a prophylaxis against fetal and neonatal alloimmune thrombocytopenia (FNAIT). DO has received research funding to a project “Towards routine HPA-screening in Pregnancy”. NS and DMA are consultants for Canadian Blood Services. J Bussel is a consultant of Baxalta, Superior Biologics and Prophylix Pharma. The remaining authors report no conflict of interest.

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Members of the International Collaboration for Transfusion Medicine Guidelines (ICTMG) are listed below the Acknowledgements.

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Baker, J.M., Shehata, N., Bussel, J. et al. Postnatal intervention for the treatment of FNAIT: a systematic review. J Perinatol 39, 1329–1339 (2019). https://doi.org/10.1038/s41372-019-0360-7

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